1
|
Sédat J, Arnoffi P, Poirier F, Jamjoom M, Raffaelli C, Colomb F, Chau Y. Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH). CVIR Endovasc 2023; 6:54. [PMID: 37922055 PMCID: PMC10624789 DOI: 10.1186/s42155-023-00402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND This study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH). RESULTS Ten consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score. Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE. CONCLUSIONS PAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted. TRIAL REGISTRATION IDRCB, 2021-AO29-56-35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1 .
Collapse
Affiliation(s)
- Jacques Sédat
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France.
| | - Paolo Arnoffi
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Florent Poirier
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Modhar Jamjoom
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Charles Raffaelli
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Frederic Colomb
- Hôpital de Grasse. Chemin de Clavary, Service d'urologie, 06130, Grasse, France
| | - Yves Chau
- Service de NeuroInterventionnel, CHU de Nice, Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| |
Collapse
|
2
|
Minici R, Guerriero P, Fontana F, Venturini M, Guzzardi G, Piacentino F, Coppola A, Spinetta M, Siciliano A, Serra R, Costa D, Ielapi N, Santoro R, Brunese L, Laganà D. Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1606. [PMID: 37763725 PMCID: PMC10537405 DOI: 10.3390/medicina59091606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.
Collapse
Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy;
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | | | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.); (D.L.)
| |
Collapse
|
3
|
Minici R, Venturini M, Fontana F, Guzzardi G, Pingitore A, Piacentino F, Serra R, Coppola A, Santoro R, Laganà D. Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040710. [PMID: 37109668 PMCID: PMC10146444 DOI: 10.3390/medicina59040710] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as "magma-like" progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy.
Collapse
Affiliation(s)
- Roberto Minici
- Radiology Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | | | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
| |
Collapse
|
4
|
Shahin Y, Dixon S, Kerr K, Cleveland T, Goode SD. Endovascular aneurysm repair offers a survival advantage and is cost-effective compared with conservative management in patients physiologically unfit for open repair. J Vasc Surg 2023; 77:386-395.e3. [PMID: 36152982 DOI: 10.1016/j.jvs.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The endovascular aneurysm repair-2 (EVAR-2) trial suggested that EVAR in patients unfit for open surgical repair (OSR) failed to provide a significant overall survival advantage compared with conservative management. The aim is to compare survival and cost-effectiveness in patients with poor cardiopulmonary exercise test (CPET) metrics who underwent EVAR or were managed conservatively. METHODS A prospective database of all CPETs (1435 patients) performed to assess preoperative fitness for abdominal aortic aneurysm repair was maintained. A total of 350 patients deemed unfit for OSR underwent EVAR or were managed conservatively. A 1:1 propensity-matched analysis incorporating age, gender, anaerobic threshold, and aneurysm size was used to compare survival. Cost-effectiveness analysis was based on the economic model for the National Institute for Health and Care Excellence clinical guideline on abdominal aortic aneurysm treatment. RESULTS Propensity matching produced 122 pairs of patients in the EVAR and conservative management groups. The median overall survival for the EVAR group was significantly longer than that for the conservative management group (84 vs 30 months, P < .001). One-, three-, and five-year mortality in the EVAR group was 7%, 40%, and 68%, respectively, compared with 25%, 68%, and 82% in the conservative management group, all P < .001. The increment cost-effectiveness ratio for EVAR was £8023 (US$11,644) per quality-adjusted life year gained compared with £430,602 (US$624,967) in the National Institute for Health and Care Excellence guideline, which is based on EVAR-2 results. CONCLUSIONS EVAR offers a survival advantage and is cost-effective in selected patients deemed unfit for OSR based on CPET compared with conservative management.
Collapse
Affiliation(s)
- Yousef Shahin
- Sheffield Vascular Institute, Northern General Hospitals, Sheffield, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; SAMRC/WITS Centre for Health Economics and Decision Science-PRICELESS, Johannesburg, South Africa
| | - Karen Kerr
- Department of Anaesthesia, Sheffield Teaching Hospitals, Sheffield, UK
| | - Trevor Cleveland
- Sheffield Vascular Institute, Northern General Hospitals, Sheffield, UK
| | - Stephen D Goode
- Sheffield Vascular Institute, Northern General Hospitals, Sheffield, UK.
| |
Collapse
|
5
|
Rabuffi P, Bruni A, Antonuccio EMG, Saraceni A, Vagnarelli S. Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study. CVIR Endovasc 2023; 6:2. [PMID: 36697892 PMCID: PMC9877256 DOI: 10.1186/s42155-023-00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To evaluate feasibility, safety and effectiveness of transarterial embolization of acute non-neurologic hemorrhage with Ethylene Vynil Alcohol Copolymer (EVOH). METHODS Between January 2018 and June 2021, 211 patients (male 123, mean age 69.7 y + 17.9) who underwent transarterial embolization with Onyx™ for acute non-neurologic arterial bleeding were retrospectively reviewed. Most frequent etiology of bleeding was post-operative (89/211, 42.2%), trauma (62/211, 29.4%) and tumor (18/211, 8.5%). Technical success was defined as the angiographic evidence of target vessel complete occlusion. Clinical success was defined as resolution of bleeding. Any rebleeding within the primitive site, requiring a new intervention during the first 30-days following embolization, was considered a clinical failure. Occurrence of procedure-related complication and mortality within 30 days of the embolization were examined. RESULTS A total of 229 embolization procedures was performed in 211 pts.; technical success rate was 99.5% (210/211 pts). Clinical success rate was 94.3% (199/211 pts). In 11 patients (5.2%) a reintervention was needed because of a rebleeding occurring within the primitive site, whereas in five patients (2.4%) rebleeding occurred within a site different from the primitive. Factors more often associated with clinical failure were coagulopathy/ongoing anticoagulant therapy (5/11, 45.4%), and post-operative etiology (3/11, 27.3%). EVOH was used as the sole embolic agent in 214/229 procedures (93.4%), in association with coils in 11 cases (4.8%), and with microparticles in 4 cases (1.7%). In the present series, major complications occurred in 6 cases (2.8%): respectively, four cases (1.9%) of colonic ischemia and two groin hematomas (0.9%) with active extravasation were observed. 26 (12.3%) patients died during the follow-up. CONCLUSION Embolization of acute arterial bleeding with EVOH as a first-line embolic agent is feasible, safe and effective.
Collapse
Affiliation(s)
- Paolo Rabuffi
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Antonio Bruni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Enzo Maria Gabriele Antonuccio
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Andrea Saraceni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Simone Vagnarelli
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| |
Collapse
|
6
|
Liquid Embolization of Peripheral Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer in Neonates and Infants. Cardiovasc Ther 2022; 2022:1022729. [PMID: 35936795 PMCID: PMC9313932 DOI: 10.1155/2022/1022729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
In the postnatal period, extensive peripheral arteriovenous malformations (AVM) are associated with high morbidity, especially when localized in the liver. Their urgent treatment is always a challenging problem in neonates and infants. We analyzed four consecutive children aged three days to three years who underwent eight liquid embolization procedures with ethylene-vinyl alcohol copolymer. The AVM were situated on the thoracic wall, in the liver, and on the lower leg. In three cases, the malformations showed total regression. The tibial AVM degenerated widely. If impaired beforehand, cardiac or hepatic function normalized after the interventions. There were no embolization-associated complications such as nontarget embolization or tissue ischemia. We conclude that application of ethylene-vinyl alcohol copolymer seems to be a safe therapeutic option and can be used in neonates and infants with peripheral AVM in consideration of the agent's characteristics. Nevertheless, there are still hardly any data concerning young children.
Collapse
|
7
|
Emerging Polymer Materials in Trackable Endovascular Embolization and Cell Delivery: From Hype to Hope. Biomimetics (Basel) 2022; 7:biomimetics7020077. [PMID: 35735593 PMCID: PMC9221114 DOI: 10.3390/biomimetics7020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Minimally invasive endovascular embolization is a widely used clinical technique used for the occlusion of blood vessels to treat various diseases. Different occlusive agents ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) (PVA) have been commercially used for embolization. However, these agents have some drawbacks, such as undesired toxicity and unintended and uncontrolled occlusion. To overcome these issues, several polymer-based embolic systems are under investigation including biocompatible and biodegradable microspheres, gelling liquid embolic with controlled occlusive features, and trackable microspheres with enhanced safety profiles. This review aims to summarize recent advances in current and emerging polymeric materials as embolization agents with varying material architectures. Furthermore, this review also explores the potential of combining injectable embolic agents and cell therapy to achieve more effective embolization with the promise of outstanding results in treating various devastating diseases. Finally, limitations and challenges in developing next-generation multifunctional embolic agents are discussed to promote advancement in this emerging field.
Collapse
|
8
|
Loffroy R, Guillen K, Chevallier O. Is Ethylene-Vinyl Alcohol Copolymer Really as Cost-Effective as N-Butyl Cyanoacrylate Glue for Transcatheter Arterial Embolization of Gastrointestinal Bleeding in the United States and Outside? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:318-319. [PMID: 35094804 DOI: 10.1016/j.jval.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/29/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France.
| | - Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| |
Collapse
|
9
|
Venturini M, Piacentino F, Coppola A, Bettoni V, Macchi E, De Marchi G, Curti M, Ossola C, Marra P, Palmisano A, Cappelli A, Basile A, Golfieri R, Cobelli FD, Piffaretti G, Tozzi M, Carcano G, Fontana F. Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J Clin Med 2021; 10:2520. [PMID: 34200171 PMCID: PMC8201262 DOI: 10.3390/jcm10112520] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator's experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.
Collapse
Affiliation(s)
- Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Valeria Bettoni
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
| | - Marco Curti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Christian Ossola
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| | - Paolo Marra
- Department of Diagnostic Radiology, Giovanni XXIII Hospital, Milano-Bicocca University, 24127 Bergamo, Italy;
| | - Anna Palmisano
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy;
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.C.); (R.G.)
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, San Raffaele School of Medicine Vita-Salute University, 20132 Milan, Italy; (A.P.); (F.D.C.)
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Vascular Surgery Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
- Department of General, Emergency and Transplants Surgery, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.P.); (A.C.); (V.B.); (E.M.); (G.D.M.); (F.F.)
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy; (M.C.); (C.O.); (G.P.); (M.T.); (G.C.)
| |
Collapse
|
10
|
Sapoval M, Vidal V, Déan C, Del Giudice C, Tradi F, Chevallier O, Charles-Nelson A, Pellerin O, Loffroy R. Safety and Efficacy of Peripheral Embolization with EASYX Liquid Embolic Agent: A Multicenter Prospective Study. J Vasc Interv Radiol 2021; 32:1136-1143. [PMID: 34098072 DOI: 10.1016/j.jvir.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the clinical safety and efficacy of EASYX, a new nonadhesive precipitating liquid embolic agent based on a polyvinyl alcohol ether polymer labeled with iodine molecules, for peripheral embolization. MATERIALS AND METHODS This open-label prospective multicenter study was conducted on 50 consecutive patients treated with embolization using EASYX in 3 academic hospitals from April 2018 to July 2019. Indications for embolization were symptomatic varicocele (n = 15), type II endoleak (n = 8), acute hemorrhage (n = 16), portal vein embolization (PVE; n = 9), or angiomyolipoma (AML; n = 2). Patient characteristics, technical and clinical success rates, pain at injection, and satisfaction of the interventional radiologists were assessed. Follow-up imaging was performed using ultrasound for varicoceles (at 1 month) and computed tomography (CT) for the other indications (at 3 or 6 months). RESULTS The immediate technical success rate was 98%. The clinical success rates were 100% for acute hemorrhage and type II endoleaks, 89% for PVE, 86% for varicoceles, and 50% for AMLs. Patients who underwent PVE showed significant hypertrophy of the future liver remnant at follow-up (P < .001), and 55.6% of patients proceeded to hepatectomy. The absence of artifacts on imaging allowed improved monitoring of the aneurysmal sac in patients with type II endoleaks. The satisfaction rate of the interventional radiologists was >90% for 5 of 7 items. CONCLUSIONS EASYX as a novel copolymer liquid embolic agent was safe and efficient for peripheral embolization. The absence of tantalum allowed reduced CT artifacts on imaging follow-up, which was especially useful in patients with type II endoleaks.
Collapse
Affiliation(s)
- Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Costantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Anaïs Charles-Nelson
- Unité d'Épidémiologie et de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - Oliver Pellerin
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| |
Collapse
|
11
|
Razavilar N, Taleshi JM. Cost-Effectiveness Analysis of Transcatheter Arterial Embolization Techniques for the Treatment of Gastrointestinal Bleeding in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:477-485. [PMID: 33840425 DOI: 10.1016/j.jval.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) bleeding is a common medical emergency associated with significant mortality. Transcatheter arterial embolization first was introduced by Rosch et al as an alternative to surgery for upper GI bleeding. The clinical success in patients with GI bleeding treated with transcatheter arterial embolization previously has been reported. However, there are no cost-effectiveness analyses reported to date. Here we report cost-effectiveness analysis of N-butyl 2-cyanoacrylate glue (NBCA) and ethylene-vinyl alcohol copolymer (Onyx) versus coil (gold standard) for treatment of GI bleeding from a healthcare payer perspective. METHODS Fixed-effects modeling with a generalized linear mixed method was used in NBCA and coil intervention arms to determine the pooled probabilities of clinical success and mortality with complications with their confidence intervals, while the Clopper-Pearson model was used for Onyx to determine the same parameters. Models were provided by the "Meta-Analysis with R" software package. A decision tree was built for cost-effectiveness analysis, and Microsoft Excel was used for probabilistic sensitivity analysis. The cost-effective option was determined based on the incremental cost-effectiveness ratio and scatter plots of incremental cost versus incremental quality-adjusted life-years. RESULTS Comparing scatter plots and incremental cost-effectiveness ratio results, -$1024 and -$1349 per quality-adjusted life-year for Onyx and N-butyl 2-cyanoacrylate glue, respectively, Onyx was the least expensive and most effective intervention. CONCLUSION Onyx was the dominant strategy regardless of threshold values. Our analyses provide a framework for researchers to predict the target clinical effectiveness for early-stage TAE interventions and guide resource allocation decisions.
Collapse
Affiliation(s)
- Negin Razavilar
- RAZN Health Decision Modelling LTD, University of Alberta Health Accelerator, Edmonton, Canada; Faculty of Sciences, University of Alberta, Edmonton, Canada.
| | | |
Collapse
|
12
|
Lucatelli P, Corona M, Teodoli L, Nardis P, Cannavale A, Rocco B, Trobiani C, Cipollari S, Zilahi de Gyurgyokai S, Bezzi M, Catalano C. Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions. J Clin Med 2021; 10:jcm10040701. [PMID: 33670124 PMCID: PMC7916888 DOI: 10.3390/jcm10040701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/26/2023] Open
Abstract
Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels. Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy. Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding.
Collapse
|
13
|
Gautier S, Chevallier O, Mastier C, d'Athis P, Falvo N, Pilleul F, Midulla M, Rat P, Facy O, Loffroy R. Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience. Quant Imaging Med Surg 2021; 11:797-809. [PMID: 33532278 DOI: 10.21037/qims-20-808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer. Methods Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR). Results Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE. Conclusions Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.
Collapse
Affiliation(s)
- Sébastien Gautier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Charles Mastier
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe d'Athis
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Frank Pilleul
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Patrick Rat
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| |
Collapse
|
14
|
Molina-Nuevo JD, López-Martínez L, Pedrosa-Jiménez MJ, Juliá-Molla E. Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia. CVIR Endovasc 2020; 3:64. [PMID: 32923979 PMCID: PMC7479391 DOI: 10.1186/s42155-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fibromuscular dysplasia (FMD) is an uncommon vascular disease that results in stenosis, dissection or aneurysmal degeneration. However, it can sometimes manifest atypically, as we show in this case. Case presentation A 24-year old patient with no relevant medical history with severe left hypochondrium pain. The physical examination showed blood pressure levels of 160/90 mmHg. An abdominopelvic CT evidenced left retroperitoneal haematoma associated with active bleeding and left renal artery stenosis. Given these findings, it was decided to perform an endovascular treatment. Significant stenosis was seen during the arteriography in both renal arteries, suggesting fibromuscular dysplasia and development of a collateral neovascular network responsible for the retroperitoneal haematoma. It was embolised in association with angioplasty of the left renal artery. The patient had a favourable outcome; however, high blood pressure levels persisted. A new bilateral renal angioplasty was performed, which returned blood pressure values to normal. The patient was discharged without needing antihypertensives. Conclusions FMD is a rare disease that can show multiple clinical presentations and need individualized treatment options. Endovascular techniques are in the first therapeutic line regarding fibromuscular dysplasia.
Collapse
|
15
|
Lehti L, Söderberg M, Mellander H, Wassélius J. Iterative metal artifact reduction in aortic CTA after Onyx®-embolization. Eur J Radiol Open 2020; 7:100255. [PMID: 32944593 PMCID: PMC7481136 DOI: 10.1016/j.ejro.2020.100255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022] Open
Abstract
The iMAR algorithms can reduce the severe metal artifacts from Onyx® glue-casts in CTA. The iMAR algorithms restores non-diagnostic examinations to acceptable diagnostic quality in most cases. It is beneficial to use several iMAR algorithms to ensure an optimal result.
Purpose Onyx® embolization causes severe artifacts on subsequent CT-examinations, thereby seriously limiting the diagnostic quality. The purpose of this work was to compare the diagnostic quality of the tailored metal artifact reducing algorithms iMAR to standard reconstructions of CTA in patients treated with Onyx® embolization. Method Twelve consecutive patients examined with Dual Energy CTA after Onyx® embolization were included. One standard image dataset without iMAR, and eight image datasets with different iMAR algorithms were reconstructed. Mean attenuation and noise were measured in the aorta or iliac arteries close to the Onyx® glue-cast and compared to the reference level in the diaphragmatic aorta. Mean attenuation and noise were also measured in the psoas muscle close to the Onyx®-glue and compared to the reference level in the psoas muscle at the level of the diaphragm. Subjective image quality and severity of artifacts was assessed by two experienced interventional radiologists blinded to reconstruction details. Results All iMAR reconstructions had less distortion of the attenuation than the standard reconstructions and were also rated significantly better than the standard reconstructions by both interventional radiologists. Conclusion The iMAR algorithms can significantly reduce metal artifacts and improve the diagnostic quality in CTA in patients treated with Onyx® embolization, in many cases restoring non-diagnostic examinations to acceptable diagnostic quality.
Collapse
Affiliation(s)
- Leena Lehti
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Marcus Söderberg
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden.,Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Helena Mellander
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - Johan Wassélius
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Neuroradiology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
16
|
Salaskar AL, Razjouyan F, Cho AL, Sood RR, Akman A, Scher D, Venbrux AC, Sarin SN. Single institutional experience of peripheral applications of a liquid embolic agent: Ethylene Vinyl Alcohol Copolymer. CVIR Endovasc 2020; 3:38. [PMID: 32743749 PMCID: PMC7396416 DOI: 10.1186/s42155-020-00117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of ethylene vinyl alcohol (EVOH) copolymer for the treatment of a variety of peripheral vascular pathologies. RESULTS Between October 2010 and October 2017, 43 patients who underwent total 54 EVOH embolization procedures for the treatment of peripheral vascular pathologies were included. The cases which involved the use of EVOH for the treatment of nonvascular, neurologic, ophthalmologic, otolaryngologic or head-neck pathologies were excluded. The demographic data, technical and clinical success rates, and procedure-related details and complications were obtained. The most common indications for EVOH embolization were type II endoleaks (n = 18) and peripheral arteriovenous malformations (n = 14). The majority of cases (62.5%) used EVOH without any adjunct embolic material. The results of this study showed 100% technical success rates and 89% clinical success rates. No events of nontarget embolization or other procedure-related complications were noted. The mortality & morbidity rates were 0%. The loss to follow up rate was 16% (9 /54). The mean follow-up period was 134 days (range, 30 to 522 days). CONCLUSION The single institutional experience supports the safety and efficacy of EVOH embolization in the treatment of various peripheral vascular conditions.
Collapse
Affiliation(s)
- Abhijit L Salaskar
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA.
| | - Faezeh Razjouyan
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Alexander L Cho
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Rishi R Sood
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Andrew Akman
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Daniel Scher
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Anthony C Venbrux
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Shawn N Sarin
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| |
Collapse
|
17
|
Rose SC, Berman ZT, Fischman AM, Young LB, Flanagan S, Katz MD, Diiulio M, Kuban JD, Golzarian J. Inline Balloon Occlusion-Assisted Delivery of Ethylene Vinyl Alcohol Copolymer for Peripheral Arterial Applications: A Multicenter Case Series. J Vasc Interv Radiol 2020; 31:986-992. [PMID: 32414569 DOI: 10.1016/j.jvir.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess the feasibility, safety, and efficacy of balloon-assisted delivery of ethylene vinyl alcohol copolymer (EVOH) for a range of peripheral arterial applications. MATERIALS AND METHODS Six academic medical centers entered retrospective data on 46 consecutive patients (27 men, 19 women; ages, 11-94 y; mean age, 50.3 y) who underwent 60 balloon-assisted EVOH procedures. The cohort was restricted to procedures involving peripheral, nonneural arteries 1-5.5 mm in diameter. Clinical indications included a wide range of vascular pathologic conditions (most commonly arteriovenous malformations [n = 20], renal angiomyolipomas [n = 8], and acute hemorrhage [n = 9]) and targeted visceral and musculoskeletal peripheral arteries. Data collected included sex, age, clinical indication, arterial pathology, arteries embolized, type of occlusion balloon microcatheter, type and concentration of EVOH agent, effectiveness as an embolic backstop, vessels protected, adequacy of EVOH cast penetration, catheter extraction, nontarget embolization, and complications. RESULTS Balloon occlusion prevented EVOH reflux in 59 of 60 procedures (98.3%). Nontarget EVOH embolization occurred in 2 procedures (3.3%). Adequate EVOH cast penetration and complete filling of the target pathologic structure were seen in 57 of 60 procedures (95%). Balloon deflation and uneventful extraction occurred in all procedures; small EVOH fragments detached into target arteries in 2 cases. One major (1.7%) and 2 minor (3.3%) complications occurred. CONCLUSIONS Balloon-assisted EVOH embolization of peripheral arteries is feasible, safe, effective, and versatile. The primary advantage of balloon-assisted EVOH embolization is the ability to apply more injection pressure to advance the EVOH cast assertively into the pathologic structure(s).
Collapse
Affiliation(s)
- Steven C Rose
- Department of Radiology, University of California, San Diego, Health Sciences, 200 W. Arbor Dr., San Diego, CA 92103-8756.
| | - Zachary T Berman
- Department of Radiology, University of California, San Diego, Health Sciences, 200 W. Arbor Dr., San Diego, CA 92103-8756; Department of Radiology, Naval Medical Center, San Diego, California
| | - Aaron M Fischman
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Lindsay B Young
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Siobhan Flanagan
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Michael D Katz
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark Diiulio
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joshua D Kuban
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
18
|
Boumezrag M, Ummat B, Reiner J, Venbrux A, Sarin S. Pseudoaneurysm: a rare complication of distal transradial access in the anatomical snuffbox. CVIR Endovasc 2019; 2:21. [PMID: 32026197 PMCID: PMC6966357 DOI: 10.1186/s42155-019-0064-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This report presents a case of distal radial artery pseudoaneurysm following cardiac catheterization and its successful endovascular management. Due to its novelty as a catheterization site, few to no reports exist regarding the complications associated with distal radial access. CASE PRESENTATION A patient presented to the emergency department with severe wrist and hand swelling 48 h after successful cardiac catheterization via distal radial artery access. Angiography revealed a pseudoaneurysm which was embolized with Onyx™. Post intervention angiogram showed exclusion of the pseudoaneurysm and preservation of the left palmar arch vasculature. CONCLUSION The case presented herein demonstrates a rare complication of distal radial access at the anatomical snuffbox.
Collapse
Affiliation(s)
- Maryam Boumezrag
- Department of Radiology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Bianca Ummat
- Department of Medicine, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Jonathan Reiner
- Department of Medicine, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Anthony Venbrux
- Department of Radiology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Shawn Sarin
- Department of Radiology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA.
| |
Collapse
|
19
|
Ierardi AM, Pesapane F, Arrichiello A, Fontana F, Piacentino F, Carrafiello G. Migration of Ethylene Vinyl Alcohol Co-Polymer in the Urinary Tract Successfully Managed. ACTA ACUST UNITED AC 2019; 55:medicina55060234. [PMID: 31159307 PMCID: PMC6630371 DOI: 10.3390/medicina55060234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 01/15/2023]
Abstract
Selective embolization is the treatment of choice for traumatic renal pseudoaneurysm. The use of ethylene vinyl alcohol copolymer (EVOH) was recently described as an embolic agent in peripheral lesions. The aim of a good embolic agent is to: achieve rapid and effective embolization; reach and fill distal vasculature targeted for embolization; be easy to prepare and use. Moreover, it should be highly radiopaque, controllable during administration, biocompatible and cost-effective. EVOH is a non-adhesive embolic agent and its efficacy is independent from the coagulant status. The risk of non-targeted embolization should be reduced by the good radio-opacity of the embolic material that is injected under continuous fluoroscopy. Nevertheless, symptomatic EVOH migration was described. We report a unique case of embolization of a renal pseudoaneurysm and migration of EVOH in the urinary tract. Retrograde trans-urethral removal of the migrated embolic agent was successfully performed. Our case report indicates that EVOH may not be appropriate when a fistula with renal calyx is suspected, even if its migration in the urinary tract may be managed.
Collapse
Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Filippo Pesapane
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy.
| | - Antonio Arrichiello
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Federico Fontana
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Filippo Piacentino
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
| |
Collapse
|
20
|
Management of spontaneous soft-tissue hemorrhage secondary to anticoagulant therapy: A cohort study. Am J Emerg Med 2018; 36:2177-2181. [DOI: 10.1016/j.ajem.2018.03.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
|
21
|
Breguet R, Boudabbous S, Pupulim LF, Becker CD, Rubbia-Brandt L, Toso C, Ronot M, Terraz S. Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate. Eur Radiol 2018; 28:4810-4817. [PMID: 29789913 DOI: 10.1007/s00330-018-5476-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE). METHODS Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3-6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed. RESULTS EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week. CONCLUSION EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation. KEY POINTS • EVOH is another effective liquid embolic agent for preoperative PVE. • EVOH is relatively simple to handle with a minimal risk of non-target embolisation. • During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.
Collapse
Affiliation(s)
- Romain Breguet
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Lawrence F Pupulim
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Christoph D Becker
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Maxime Ronot
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Department of Radiology, University Hospitals of Beaujon, Paris, France
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.
| |
Collapse
|
22
|
Né R, Chevallier O, Falvo N, Facy O, Berthod PE, Galland C, Gehin S, Midulla M, Loffroy R. Embolization with ethylene vinyl alcohol copolymer (Onyx ®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study. Quant Imaging Med Surg 2018; 8:280-290. [PMID: 29774181 DOI: 10.21037/qims.2018.04.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Onyx® is a liquid embolic agent, which is approved for the treatment of cerebral vascular lesions but still rarely used in peripheral interventional radiology. The goal of this study is to report the feasibility and safety of embolization with Onyx® for peripheral hemostatic and non-hemostatic endovascular procedures. Methods Retrospective study of all consecutive patients who underwent visceral or peripheral embolization with Onyx® for hemostatic or non-hemostatic purpose in our department between May 2014 and November 2016. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular procedure, pain during embolization, outcomes, and follow-up data were collected. Results Fifty patients (males, 34; females, 16; mean age, 56±18 years; range, 15-89 years) were included. Twenty-nine (58%) of patients underwent hemostatic embolization for arterial (n=22, 44%) or venous (n=7, 14%) bleeding lesions, whereas 21 (42%) of patients underwent non-hemostatic embolization for arterial aneurysms (n=8, 16%), preoperative portal vein deprivation (n=6, 12%) or other indications (n=7, 14%). Onyx-18 was used in 37 (74%) patients, Onyx-34 in 9 (18%) patients, and a combination of both in 4 (8%) patients. Onyx was used alone in 25 (50%) patients and in combination with other agent in 25 (50%) patients. Mean number of Onyx® vials used was 3.7 (range, 1-17). Immediate technical success rate was 100%. Primary clinical success was achieved in all patients. Recurrent bleeding occurred in two patients. Significant pain (pain score ≥3) was noted during injection in 10 (20%) patients. No major complication or side effects were noted within 1 month. Conclusions Transcatheter embolization with Onyx® is feasible and safe in the peripheral arterial or venous vasculature for both bleeding and non-bleeding patients whatever the anatomic site.
Collapse
Affiliation(s)
- Romaric Né
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Nicolas Falvo
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Olivier Facy
- Department of Digestive and Visceral Surgery, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Pierre-Emmanuel Berthod
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Christophe Galland
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Sophie Gehin
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| |
Collapse
|
23
|
Reply to the Letter: “N-Butyl Cyanoacrylate Glue: The Best Hemostatic Embolic Agent for Patients with Acute Arterial Bleeding”. Cardiovasc Intervent Radiol 2017; 40:1292. [DOI: 10.1007/s00270-017-1684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/28/2017] [Indexed: 11/27/2022]
|
24
|
Poly(acrylic acid) microspheres loaded with superparamagnetic iron oxide nanoparticles for transcatheter arterial embolization and MRI detectability: In vitro and in vivo evaluation. Int J Pharm 2017; 527:31-41. [DOI: 10.1016/j.ijpharm.2017.04.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/17/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023]
|
25
|
Haskal ZJ. The Liquid Life. J Vasc Interv Radiol 2017; 28:840-841. [DOI: 10.1016/j.jvir.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
|
26
|
Urbano J, Paul L, Cabrera M, Alonso-Burgos A, Gómez D. Elective and Emergency Renal Angiomyolipoma Embolization with Ethylene Vinyl Alcohol Copolymer: Feasibility and Initial Experience. J Vasc Interv Radiol 2017; 28:832-839. [DOI: 10.1016/j.jvir.2017.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/15/2017] [Accepted: 01/26/2017] [Indexed: 01/04/2023] Open
|
27
|
Poursaid A, Jensen MM, Huo E, Ghandehari H. Polymeric materials for embolic and chemoembolic applications. J Control Release 2016; 240:414-433. [PMID: 26924353 PMCID: PMC5001944 DOI: 10.1016/j.jconrel.2016.02.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 12/18/2022]
Abstract
Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.
Collapse
Affiliation(s)
- Azadeh Poursaid
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Mark Martin Jensen
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Eugene Huo
- Veterans Affairs Hospital, Salt Lake City, UT 84108, USA
| | - Hamidreza Ghandehari
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA.
| |
Collapse
|
28
|
Abstract
Abdominal trauma accounts for nearly 20% of all traumatic injuries. It often involves young patients sustaining multiple injuries, with a high associated mortality rate. Management should begin at the scene of injury and relies on a structured chain of care in order to transport the trauma patient to the appropriate hospital center. Management is multi-disciplinary, involving intensive care specialists, surgeons and radiologists. Imaging to precisely define injury is best performed with whole body dual phase computed tomography, which can also identify the source of bleeding. Non-operative management has developed considerably over the years: this includes selective embolization in case of active bleeding or vascular anomalies in stable or stabilized patients after resuscitation. Embolization has become one of the corner stones of abdominal trauma management and interventional radiologists must play an active role on the trauma team. This overview details the different embolization procedures according to the involved organ and embolic agent used.
Collapse
Affiliation(s)
- J Frandon
- Clinique Universitaire de Radiologie et d'Imagerie Médicale CURIM, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France; CHU de Nîmes, 4, rue du Professeur-Robert-Debré, 30029 Nîmes, France.
| | - C Arvieux
- Clinique Universitaire de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - F Thony
- Clinique Universitaire de Radiologie et d'Imagerie Médicale CURIM, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| |
Collapse
|